Frequentie en kenmerken van gebruik van morfine in de stervensfase

Objective

Intensive use of morphine at the end of life sometimes seems to represent a grey area between active ending of life and regular alleviation of symptoms. We explored the most important characteristics of use of morphine at the end of life.

Design

Cross-sectional questionnaire study.

Method

A stratified sample was drawn of death cases that occurred in the Netherlands in 2010. Physicians were asked to fill out a questionnaire on medical decisions and care that had preceded death. The response rate was 74% (n = 6598).

Results

On the last day of life, 60% of all deceased patients received morphine. In 64% of the patients, the physician took into account that the use of morphine might hasten death. In 82%, the dosage was not or only gradually increased during the last 3 days of life. Hastening of death had been part of the purpose of administering morphine in 2.9% of the patients and the explicit purpose in 1.2%. In 2.1% of the patients, the physician indicated that the dosage was higher than needed to alleviate symptoms. Possible hastening of death as a result of the administration of morphine was not always discussed with the patient, his family or other caregivers; in 20% of the cases, it had not been discussed with anyone.

Conclusion

Morphine is frequently used at the end of life. Physicians take more often than necessary into account that morphine potentially hastens death. Occasionally, morphine is deliberately used in higher dosages than needed with the aim of hastening death. Such practices may not always be compliant with legal and professional regulations to promote transparency and patient-centred care at the end of life.

Conflict of interest: a disclosure form provided by the author is available along with the full text of this article at www.ntvg.nl, search for A6857; click on ‘Belangenverstrengeling’ (‘Conflict of interest’). Financial support: authors received a grant from The Netherlands Organisation for Health Research and Development (ZonMW) for this study.